The DH report is merely an analysis of responses to the consultation, but the MHRA says

"The Health Professions Council (HPC) has now been asked to establish a statutory register for practitioners supplying unlicensed herbal medicines. The proposal is, following creation of this register, to make use of a derogation in European medicines legislation (Article 5 (1) of Directive 2001/83/EC) that allows national arrangements to permit those designated as “authorised healthcare professionals” to commission unlicensed medicines to meet the special needs of their patients."

The MHRA points out that this started 11 years ago with the publication of the House of Lords report (2000). Both that report, and the government’s response to it, set the following priorities. Both state clearly

“… we recommend that three important questions should be addressed in the following order . .

(1) does the treatment offer therapeutic benefits greater than placebo?

(2) is the treatment safe?

(3) how does it compare, in medical outcome and cost-effectiveness, with other forms of treatment?

The report of DH and the MHRA’s response have ignored totally two of these three requirements. There is no consideration whatsoever of whether treatments work better than placebo (point one) and there is no consideration whatsoever of cost-effectiveness (point 3). These two important recommendations in the Houss of Lords report have simply been brushed under the carpet.

Needless to say, herbalists are head over heels with joy at this sign of official endorsement (here is one reaction)

Here are my first reactions. The post will be updated soon.

The DH report is, in a sense, democratic. They have simply counted the responses, for and against each proposal. They seem to be quite unaware that most of the responses come from High Street herbailsts whose main aim is to gain respectability. The response of the Academy of Royal Medical Colleges counts as one vote, just the same as the owner of a Chinese medicine shop. This is not how health policy should be determined. Some intervention of the brain is needed, but that isn’t apparent in the report.

At present the HPC regulates Arts therapists, biomedical scientists, chiropodists/podiatrists, clinical scientists, dietitians, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, prosthetists/orthotists, radiographers and speech & language therapists. I shudder to think what all these good people will think about being lumped together with people who practice evidence-free medicine (or, worse, forms of medicine where there is good evidence that they don’t work).

The vast majority of herbalists, traditional Chinese medicine (TCM) and acupuncture has no good evidence that it works, In the case of soem herbal medicines and acupuncture, there is good evidence that they don’t work. Yet the HPC has, as one of its criteria, that aspiring to be regulated by them requires

Another mistake made by the Department of Health regards the value of "training". The report (page 11) says

Would statutory regulation lessen the risk of harm? (Q2)
Again, the vast majority of respondents thought it would. Reasons given were that statutory regulation would ensure that herbal practitioners and acupuncturists are carefully and thoroughly trained. That training is subject to accreditation, evaluation and periodic review by independent educational and training professionals, and disciplinary oversight by a regulating body. Incompetent or unscrupulous practitioners could be struck off the register and prevented from practising.

Although it is pointed out to them in several responses, the Department of Health seems quite incapable of understanding a simple and obvious truth. Spending three years training people to learn things that are not true, safeguards nobody. On the contrary, it endangers the public. Training in nonsense is obviously a nonsense.

At the end of the report is a list of organisations who responded, As expected, they are predominantly trade bodies that have a vested interest in allowing thinks to be sold freely regardless of whether they work or not. The first four are Alliance of Herbal Medicine Practitioners. European herbal and Traditional Medicine Practitioners Association (ETMPA), Association Chinese Medicine Practitioners (UK) (ACMP) and Acupuncture Society. And so on.

More coming soon.

Follow-up

16 February 2011. Later the same day, we see one reason why Michael Mcintyre, chair of the European Herbal Practitioners Association, got what he wanted to promote his trade. They had evidently hired a PR Agency, Cogitamus, to push their case. Now they are crowing about their victory. And of course his profits were not harmed by the free publicity that was given to his cause by the BBC,

The pinheads in the Department of Health are more easily persuaded by a PR agency than by any number of people who know a lot more about it, and who have no profit motive.

The Metro article elicited a fine bit of abuse from a Lynda Kane. I’m constantly amazed at the downright viciousness of cuddly holistic therapists when they get found out. I guess it is just another bad case of cognitive dissonance. I can’t resist a few quotations.

“As a scientist myself, I abide by the virtues of open-minded neutrality and accepting the hypothesis until proven otherwise by null-hypothesis based research.”

“How many of the innumerable studies on the efficacy of herbal medicine have you read? “

“Perhaps in your ‘day’ professors could say whatever they liked and be listened to. That day is long gone, as you must know from the various law-suits you have been party to.”

I love the idea that statistics allow you to accept any hypothesis whatsoever until someone shows it to be wrong.

This would be funny if it were not so sad (and rather painful). As always I replied politely and referred her to NCCAM’s Guide to Herbs, so she can check up on that plethora of evidence that she seems to think exists.

This is Lynda Kane of energyawareness.org. I can recommend her web site, if you want some truly jaw-dropping woo. She’ll sell you a “White Jade Energy Egg – may provide up to 5 times as much protection from wifi and from other peoples’ energies – costs £47.00”. Hmm, sounds good. How does it work? Easy.

“The human energy or “qi” field is shaped like an egg. It is being attacked by many forms of natural and man-made environmental stress 24 hours a day.”

I guess that’s OK according to Ms Kane’s interpretation of statistics which allows you to accept any hypothesis whatsoever until someone shows it to be wrong.

Nothing visible happened after this announcement. Until the government’s resident medical loon, David Tredinnick MP forced a debate on the matter. His introduction to the debate was his usual make-believe. Sadly it made much of an exhibit at the Royal Society Summer Science exhibition -a bit of bait and swich by aromatherapists.

After ploughing your way through pages of nonsense, you get to the interesting bit. At 10.38 am, The Parliamentary Under-Secretary of State for Health, Dr Daniel Poulter, announced what was happening. It seems that there may, after all, have been some effect of all the sensible submissions which pointed out the impossibility of regulating nonsense. The question of regulation has, yet again, been postponed.

"To ensure that we take forward the matter effectively, we want to bring together experts and interested parties from all sides of the debate to form a working group that will gather evidence and consider all the viable options in more detail,"

One wonders who will be on this working group? If they don’t choose the right people, it could be as bad as the Pittilo report. It wasn’t reassuring to read

" we want to set up a working group and to work with my hon. Friend [Tredinnick], and herbalists and others, to ensure that the legislation is fit for purpose."

67 Responses to Government lends credibility to quacks and charlatans

Zeno makes an interesting comment on the earlier post, Pseudo-regulation: another chance to save the MHRA from looking idiotic.

He points out that the Advertising Standards can do nothing about misleading claims when the source of the misleading claim is the MHRA.

It is not clear to me whether the MHRA’s decisions about allowable claims are also immune to the Consumer Protection Regulations (2008) and the Cancer Act (1939). (See Most Alternative Medicine is Illegal). I certainly hope not, because if they were, there would be no protection left against false health claims.

If these laws still apply, and IF Trading Standards can be made to enforce them, then we could end up with the HPC being prosecuted for allowing false claims to be made.

‘At present the HPC regulates Arts therapists, biomedical scientists……… I shudder to think what all these good people will think about being lumped together with people who practice evidence-free medicine.’

And

“… we recommend that three important questions should be addressed in the following order . .
• (1) does the treatment offer therapeutic benefits greater than placebo?

I think biomedical scientists might feel a little aggrieved at being placed after Art therapists on your list. Can art therapy be scientifically assessed? Is there a significant evidence base for the efficacy of Art therapy showing it to be greater than placebo as there is for treatments based on biomedical science? How were the experiments carried out? Is colour better than black and white? Is colour blindness a confounding factor? Is it in any way related to Thought Field Therapy (used by some NLP practitioners I believe)?
The Acupuncturists and Thought Field Therapists might feel a little put out by your comments when all they are doing is practising a little artistry themselves. A form of pointillism if you will.

I understand that point. I’ve seen the ASA assume the “if it’s OK by the MHRA, it’s OK by us” position with advertising that is in breach of the CAP codes.

But, you are missing a trick. The Medicines (Advertising) Regulations 1994 http://www.legislation.gov.uk/uksi/1994/1932/contents/made forbids the advertising of unlicensed medicines. MHRA goes further in suggesting the advertising of services naming such products is also illegal. Regulation that would allow, say, herbalists to prepare and provide clients with unlicensed medicines is one thing, but unless the Medicines (Advertising) Regulations 1994 is also amended, even mentioning unlicensed herbal products would still be illegal, let alone any claims.

And breaches of The Medicines (Advertising) Regulations 1994 are criminal acts. In theory, in a regulated profession, even the whiff of criminality should lead to formal investigation and possibly being struck off.

Statutory regulation is something that herbalists and TCM practitioners are ill prepared for.

“Is there a significant evidence base for the efficacy of Art therapy showing it to be greater than placebo as there is for treatments based on biomedical science?”

Some would argue (myself included) that there is not an impressive evidence base for e.g. SSRIs being better than placebo in most cases – but they’re probably marginally better, sometimes. The same is true for a wide range of behavioural therapies, including CBT.

The problem for biomedical science and psychiatry is that ultimately we have no idea how biology -> cognition and emotion. Neuro-psychiatric understanding, treatments (and their corresponding psychiatric disease constructs) is therefore very poor. Use what you can.

Also, I suspect (although do not know) that art therapy does not come with woo attached. Unlike NLP or TFT.

The fact that you are a Director of Wellcome Laboratories and have commercial interests in the pharmaceutical industry makes your attack on the subject of herbal medicine rather suspect.
Do you not acknowledge the fact that because Herbal Medicine is difficult to exploit commercially this has resulted in the relatively little high-quality research into their efficacy despite the growing worldwide interest in them ?
(that’s not just my comment, it’s source is: Lewith, G., Breen, A., Filshie, J., Fisher, P., Mcintyre, M., Mathie, R., Peters, D., (2003), „Complementary medicine: evidence base, competence to practise and regulation‟, Clinical Medicine (London, England), 3(3):235-240)

@misstickle
I see that you are about as good at checking your facts as most alternative medicine advocates. The Wellcome Lab that I used to direct until 2004 was funded by the Wellcome Trust, a charitable organisation that long since ceased to have any relationship with the former drug company, Burroughs Wellcome. I have never accepted drug company money for any research and I’d be obliged if you’d do your homework before making accusations.

It is right to say that few herbs have been tested properly. Those that have been are mostly found not to work (e.g. St John’s Wort and echinacea). The firms that sell them are very rich, but they choose not to use their wealth to run trials. Could that possibly be because they fear the trials would fails? I’m interested in the people you cite as authorities. They are all well-known advocates of magic medicine. You can read more about Lewith here (and also more coming soon).

…and for misstickle, Wellcome Laboratories has not existed for nearly 20 years. It merged with Glaxo to form Glaxo Wellcome, which then merged with SmithKline Beecham to become Glaxo SmithKline. Do keep up.

@David Colquhoun
I am glad to have caught your attention.
I don’t think that any serious medical herbalist would have anything to fear about any trial that might be held, as long as it was done properly and ethically. More genuine and ongoing research into the various herbs and their effects would be welcomed by all medical herbalists. The ultimate aim of all doctors and medical herbalists alike is, is it not, to help patients with their ailments and suffering?
You are of course aware that that a single medicinal herb may contain hundreds of natural constituents, and a mixed herbal preparation several times that number, and so if every active ingredient were to be isolated from every herb, the time and resources required would be tremendous and arguably, impossible (source: ‘National Policy on Traditional Medicine and Regulation of Herbal Medicines – Report of a WHO Global Survey’, [Online], Available from: http://apps.who.int/medicinedocs/en/d/Js7916e/2.html). Just because a herb’s action is complex, I do not believe that means that they should categorically ignored, surely it implies they deserves more focus and research on a more holistic rather than reductionist level.
Opening up the choice of healthcare for patients is surely a good thing, especially if it is properly regulated, as the recent announcement has ensured for medical herbalists.
Although I have nothing personally to say about homeopathy, Dr. Luc Montagnier, Nobel Prize receipient, seems to be able to open his mind to greater possibilties of healthcare http://www.huffingtonpost.com/dana-ullman/luc-montagnier-homeopathy-taken-seriously_b_814619.html

I wonder if regulating this might actually end up a positive. When medicines were first brought under a regulatory regime a lot of treatments were essentially grandfathered in, but over time the ones that don’t work or are dangerous have been weeded out so that by now most regulated medicines are both safe and effective. Would it not be good if the same happened with herbal remedies? After all, we do know some have demonstrable pharmacological effects.

@misstickle: The problem with relying on Ullman’s interpretations of science is that Ullman is a pathological liar. CBC’s Marketplace investigation team contacted Montaigner and he said that his work cannot be extended to cover homeopathy (it is a very short-lived effect of very specific types of chemicals and has not yet been replicated or understood, there is no evidence at all of persistence or generalisability).

@misstickle
Are you not aware that in the USA, NCCAM has spent of 1 billion dollars on research into alternative medicines, including quite a lot of herbal things. For all that money, they have failed to come up with anything useful. That is how we know Echinacea doesn’t work.

The fact that herbs contain many ingredients, and in unknown concentration, is one of the things that make them potentially dangerous. That’s why my Patients’ Guide to Magic Medicine has an entry:

I was not advocating that herbs should be ignored. They have an important place in the history of pharmacology. I was merely saying that herbal medicines should not be sold when there is no evidence that they work. It’s hard to see how one could object to such a statement, but he proposed regulation will not achieve that desirable goal.

You say that choice is good, and in general I agree, But it has to be informed choice. It is not good to have the choice to buy medicines that don’t work, especially when the label disguises that fact.

It seems to me that people whose position is based on faith see rational people as the same, using selected evidence to make their case so therefore just do the same themselves.
The government need to realise that you cannot have a consultation or popularity contest or vote on whether 2+2=4

The restriction of certain herbal medicines to herbalists will affect many homeopaths.

British lay homeopathy is a very diverse population. The older, more traditional British lay homeopaths were taught to use many herbs for organ support, drainage and therapeutics. This would be the original generations at College of Homeopathy (the first homeopathic college for lay homeopaths) and would include quite successful people like Mike Bridger, Linda Razzell, David Howell. Many of this generation are now very successful and have taught this to succeeding generations of homeopaths. Chelidonium (used for liver support) is regulated already but can be bought from Helios by a homeopath (does not even need to be registered – just a business card saying homeopath).

This early generation is much more the religious arm of homeopathy and tries to the repertory and materia medica.

As you will all have read, later gerations got far more caught in the magic and prefer dowsing or challing spirit guides to opening Kent or Murphy’s repertory.

To those with the old-fashioned style of practise this will be a restriction on their work.

I received an email containing “Government response to petition ‘nohomeopathy’ ”

The result was in line with the bland ‘roll over and submit’ response you report today. Sadest thing to note was there were only 1629 signatories to the petition. I cannot believe this represents the true situation so maybe the argument has to move from ‘This is the truth – believe it’ to ‘Now you believe it ACT!’

Unless we’re in a minority then rolling over may just be the best policy…

@Ravi
I very much fear that the coalition, or at least Lansley, is even less interested in evidence and science than New Labour. It is sad that we are led by anti-scientific philistines, but there have been victories as well as setbacks and we should not give up now.

@Dangerous
Michael McIntyre hired a PR agency to protect his multi-billion pound industry, devoted to selling drugs of unknown efficacy. The herbal industry is even more ruthless in maximising its income than Big Pharma. In fact sometimes the latter owns the former. Neither has great regard for truth, but at least some of the products of Big Pharma actually work. What we have seen is another victory for big business over science. I find that sad, and so should you.

When a particular treatment, tincture, homeopathic or herbal ‘medicine’ can be shown to be no better than control or with a proposed mechanism defying physical and biological understanding, then the claims of the purveyor of the miracle ‘cure’ can be dismissed and the ‘cure’ consigned to the fringes of quackery. Even when some clients report a benefit from the treatment their improvement is thought to be the result of the placebo effect.
It is rightly thought unethical to recruit, from the local Drama Society an individual, bearing a resemblance to Marcus Welby MD, kit him out like a kosher medic, and get him to administer yellow sugar pills to genuinely sick people in hospital even if the intention is that they might, at least, enjoy the benefit of the placebo effect.
Yet some treatments have so many variables that it is almost impossible to control for all but the one to be examined. Furthermore, there seems to be evidence that these approaches do indeed bring relief to many sufferers especially in the area of mental health. If there is no evidence that these treatments fare better than control (if it is indeed possible to get a control) it may be that they work as placebo. Should the NHS fund such treatments? Should such treatments rub shoulders with evidence based approaches? Should they not be treated as alternative or complementary therapy until a solid evidence base is accumulated?

‘I have no objection to the NHS funding placebos as long as they are honest about what they are doing.’

If I read you correctly you would have no objection to homeopaths saying to sick people “There is no scientific basis for this treatment and biomedical scientists say they believe the rationale is nonsense. Scientific studies, that have been carried out, suggest that at best any benefit is purely a placebo effect. Here is a leaflet prepared by Professor David Colquhoun FRS explaining the stance taken by mainstream scientists. However, we homeopaths, believe that our procedures induce a magical change in the water and I’m sure it is this magic that will relieve your pain/anxiety/etc.”
In consequence with this simple admission The Homeopathic Hospitals can open and expand. Prince Charles can dole out honours to homeopaths, Wards can be decked out with dream catchers. Patchouli oil spray can be placed next to the antibacterial handwash. Security may have to be increased to separate the competing holistic practitioners. I can expand my newly created venture, (Complementary Rubbish As Placebo) advising the humbuggers. Exaggeration of course and apologies if I have misunderstood you.

[Professor Ernst summarised the problem with prescribing placebos in the NHS: “I would argue it is unnecessary, unreliable and unethical to prescribe placebos through the NHS; …” to the House of Commons Science and Technology Committee)

I think there needs to be a more grown up debate when it comes to health care. I am happy to admit there are many herbal remedies that have no evidence base and I’d think twice about prescribing them. There are also many conventional medicines that have no evidence base but are heavily used by the NHS. As a pharmacist colleague (who is rabidly anti natural medicine) put it yesterday, when it comes to type 2 diabetes just give them simvastatin 40mg and high dose metformin and leave it at that.

A lot of herbal medicines sold over the counter I wouldn’t take. Surely. it is better that people with a pharmaceutical background get involved and ensure that evidenced based herbals are available (less of a issue in Germany) to the public and that the public are aware of the evidence base supporting many conventional medicines is weak.I’ve been teaching post-graduate nurses clinical pharmacology recently and when I show them the NNTs and Cochrane reviews for much of what they do I get some rather interesting expressions and comments.

“Surely it is better that people with a pharmaceutical background get involved and ensure that evidenced based herbals are available”

That is a lot more sensible than either the MHRA or DH, or HPC, all of which have decided to ignore entirely the question of whether anything works. It is a total betrayal of any sort of science or reason One might expect that from the pinheads in DH but one not expect it of the MHRA, or even the HPC

Just one thing though. Would you please tell is which herb you consider to have the best evidence for effectiveness?

Can we include NICE in your list? I was hoping they were going to join NPSA in the quango cull. Give the money to the NPC who do an excellent job reviewing the evidence for medicines (for a lot less money).
I can think of eight or nine disease states where herbal/natural medicine should have a role.
One area is OA where conventional medicine still believes NSAIDs have a major role. I don’t think you need me to outline their toxic profile.

Looking at alternative approaches (excuse the cut and paste I have a life to live);

Boswellia serrata review Frankincense: systematic review. BMJ. 2008 Dec 17; Ernst E. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter EX2 4NT, UK. To assess evidence from randomised clinical trials about the effectiveness of extracts of Boswellia serrata (frankincense). All randomised clinical trials of Boswellia serrata extract as a treatment for any human medical condition were included and studies of Boswellia serrata preparations combined with other ingredients were excluded. Of 47 potentially relevant studies, seven met all inclusion criteria (five placebo controlled, two with active controls). The included trials related to asthma, rheumatoid arthritis, Crohn’s disease, osteoarthritis, and collagenous colitis. Results of all trials indicated that Boswellia serrata extracts were clinically effective. Three studies were of good methodological quality. No serious safety issues were noted. The evidence for the effectiveness of Boswellia serrata extracts is encouraging but not compelling.

The studies that showed this herb to be most effective were in OA. Wouldn’t it save a lot of unnecessary NSAID related hospital admissions if the MRC were to conduct a large scale study on this herb for OA here in the UK rather than relying on China and India for the studies?

While taping someone’s knee in OA gives an NNT=1.7.
Efficacy of knee tape in the management of osteoarthritis of the knee: blinded randomised controlled trial
BMJ 2003; 327: 135

While an COX2 has an NNT=12 versus paracetamol
•Efficacy of Rofecoxib, Celecoxib and Paracetamol in OA of the Knee. A Randomised controlled Trial. Geba et al JAMA 2002; 287: 64-71

The point I’m making is that the NHS could save a significant amount of money and reduce hospital admissions if it was to take a more holistic approach. We’ve seen CBT make an appearance post SSRI meta-analysis. Can we do the same for other disease states?

Herbalism has been around for a long time now, and if this is the best evidence that’s emerged on 100s of years, I hope you’ll forgive me for being deeply unimpressed.

When I had osteoarthritis (hip), I was unimpressed by NSAIDS too. As i’ve often said elsewhere, pain is is a problem with no very satisfactory problems. modern medicine does have the solution to hip OA though. A titanium hip makes it as good as new.

Since when has RA been OA? I know they don’t teach diagnostic skills in pharmacology (unlike herbal medicine) but there is a big difference.I’m not impressed.

Boswellia serrata extracts were clinically effective.

Perhaps you should take time out to read the studies that allowed Ernst to draw this conclusion or have you already formulated your own opinions.

So you don’t think the MRC funding a UK based study on Boswellia is worthwhile or shall we just leave it to India and Germany? In the meantime we should ban NSAIDs and prevent a lot of mortality and morbidity or are you too busy campaigning on homeopathy to worry about the thousands of people that die every year through taking drugs like NSAIDs.

If you had bothered to follow the link, you would have seen that the NCCAM page refers to RA. All it says about Boswellia is that

“..no rigorous clinical trials in people with RA have been conducted.”

Since NCCAM is very pro-CAM, I think you just lost the argument. You just seem to know it works, though even NCCAM doesn’t say so. And remember this was meant to be the best example of a herb backed by evidence. Be honest, it doesn’t amount to a hill of beans.

As to whether the MRC should fund a trial, why not try to apply for a grant, just as every scientist has to do?

My, we are all in need of a camomille tea aren’t we? :0)
@David Colquhoun
Hello again (did you miss me?)
You typed:
“But it has to be informed choice”
I couldn’t agree more.
But my question to you now is, do you tar the graduate medical herbalist with the same brush as the unqualified but maybe very experienced person who runs a retail herbal shop?
For me there’s a big difference.
Statutory regulation will mean that only qualified medical herbalists (with a Bsc degree from a UK university) can prescribe unlicensed herbal preparations.

@misstickle
Yes ask about the ‘graduate’ herbalist. it is possible (but not known) that they may be a bit safer then ‘unqualified’ people, but since the ‘degrees’ consist largely of learning things that are not true, and are sometimes dangerous, they are no guarantee of anything.

The fact is that when the nonsense they teach is revealed to the public, the VCs shut down the courses, because they are an embarrassment to any university. This is one of the many problems that seem to have escaped the notice of Andrew Lansley and the Department of Health.

Cogitamus’s blog entry had a space below for comments. I couldn’t resist submitting the following:

“I think your firm missed something when it strove to help this client achieve what they did. Was it that your firm was uninformed about the implications of what the clients wished to accomplish? Egad, boys, have you no sense of responsibility to the public health? The issue of your involvement is much larger than you folks apparently can conceive. OK, here’s a start, under the heading of “critical thinking”: From http://www.dcscience.net/?p=4117 I quote
“The pinheads in the Department of Health are more easily persuaded by a PR agency than by any number of people who know a lot more about it, and who have no profit motive.”
I urge you to look into this matter and make a better decision next time about what you will do for money.

My comment is currently being moderated.

It strikes me at this instant that the struggle for reality, reason, truth, etc. is incomprehensibly large, complex, and difficult…

Oops! Since I submitted it yesterday, the above comment in response to the Cogitimus page has been “moderated” into non-existence.
I’m relatively new to actually submitting comments to places like that, so I commented again:

“Sorry your reply system is broken–it does not seem to accept replies that provoke thought or suggest action. This is probably part of P.R.? One would hope that, in this age of ever-increasing call for transparency, a dialogue might be established and I’d hear back from someone about this.
Once again, I refer you to http://www.dcscience.net/?p=4117 where our brief exchange is being posted as it progresses. There, you may come to understand this issue and also the difficulty in explaining it all in a single blog comment.”

No surprise, I suppose, because public relations people are essentially paid liars. It is irrelevant to them whether what they say is true or not. It is even irrelevant to them whether the harm people or not. If that were not the case, they wouldn’t get paid.

In this case they were hired to protect the wealthy herbal industry and that’s what they did.

If you look at the employees of Cogitamus. they appear to be fairly normal people. I don’t know how people who do that sort of job manage to sleep at night.

I’d offer a small prize to anyone who can find out what they were paid. Is there a mole with enough conscience left to tell us?

Holy crap one of those Cogitamus people is an ex-flatmate of mine. Didn’t stay in touch I’m afraid. He had stupendous, infuriating confidence in his own opinions on subjects other people knew far more about, which caused a good few flat rows as I remember.

I do think you’re being a bit hard on all PR folk though. A friend of mine used to do PR for a company that got a slap on the wrist for making unfounded health claims. She was only too glad to have it all properly explained to her – she’d basically been thrown into the task with no health/science training, and wasn’t given the time or budget to get expert consultation. It’s an incredibly competitive business with a lot of jobs under threat – so no-one’s prepared to say “Sorry, I don’t think I know enough about that”.

In 1974 I took a semester abroad (OK, I confess; I’m a Yank.) consisting of the study of European communication systems, through the TV/R Department of Ithaca College, held at the college’s London Center (Centre?) in Harrington Gardens. Over 10weeks of 14-week program, we listened to dozens of guest speakers form all areas of the mass communications system/industry in Britain and Scotland.
One highlight of the program was a trip to Ogilvy and Mather. Available television for the UK at the time included BBC 1, BBC 2, and ITV (I’m leaving out Continental and Pirate signal sources.)
Commercial television in the UK was in its infancy, but it was pointed out by their rep. that ITV did, indeed have fairly stringent rules to follow in the realm of truth in advertising. To illustrate this point, he told us about a campaign to advertise a cooking oil which included a commercial purportedly demonstrating the oil’s ability to cook a load of chips and NOT leave a big, greasy stain on the paper towel onto which the chips were then dumped. ITV had tested the same product in the same way to ensure the manufacturer was not making bogus claims. Our P.R. guy admitted that it was necessary to shake the chips an awfully long time, then remove them VERY quickly from the paper towel, otherwise, the dreaded stain would make its appearance. He further confessed that their project crew, who had been “sweating bullets” for fear that the ITV testers could/would not reproduce the same results, were in fact vindicated by the test results, merely as a result of chance: This oil actually performed no differently than all the other cooking oils on the market. (So much for small studies with poorly defined protocols)
P.R., from inception, is designed to show something in its best light, whether an idea or a product. I agree with Prion that those in the field are reticent to express any ignorance, real or perceived, willful or not. Bias, “stretching the truth,” cherry-picking the data, lying by omission or outright fraud are the mainstays of P.R. Prion’s former flatmate appears to hold a “job” where, though some may be “only too glad to have it all properly explained,” they appear to be compelled to proceed on a project nonetheless, though they find themselves in effecctive ignorance of a topic or product. If P.R. were based on reason, logic, valid information, conclusions drawn from evidence, and transparent communication, I’d tend to confuse it with conventional medicine!

Regarding the Dept of Health consultation you say that “most of the responses come from High Street herbailsts” (sic) – do you actually have any evidence of this? Or are you trying to mislead people with a statement you have just made up?

You are quite right, I have no information about individual replies. So that statement was based on the fact that I have yet to meet a scientist or medic who thought it was a good idea.

It is also based on the fact that the herbaiists, helped by the PR agency they hired, ran an intensive campaign to urge members of the EHTPA (their trade organisation) to send responses to the consultation. Scientists, on the other hand, mostly have better ways to spend their time.

There may have been the odd scientist among the 85% but I can’t imagine any real scientist thinking that it was a good idea to give degrees that teach things that have been known for a long time to be false.

Perhaps it would have been more helpful if you’d stated your opinion about what constitutes effective regulation.

If you happen to be the Andrew Hoyle who acts as PR consultant for the National Institute of Medical Herbalists, then should you not have declared you financial interests? The reader should be aware that it is your job to propagate a particular point of view regardless of truth,

I have read through the DH document: Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK.

What interested me (as a physiotherapist) was this on page 22:

Should AHMTCM practitioners be regulated in a way which differentiates them from orthodox professions? (Q12)

The great majority of respondents thought not. Some argued that the evidence base for acupuncture was in some respects as good as that for some statutorily regulated professions:

“There are many clinical interventions that are widely used within physiotherapy (for example) that do not enjoy as robust an evidence base as acupuncture but physiotherapy is perceived as a “mainstream profession”. It is evident therefore that if acupuncture were to be regulated on the strength (or weakness) of its evidence of clinical effectiveness then this would suggest a re-appraisal of many other aspects of physiotherapy and indeed some of the other professions allied to medicine. It is therefore difficult to see the advantage of regulating acupuncture in a way that differentiates it from physiotherapy”.

I suspect this assertion that acupuncture is as much, if not more evidence-based than other physiotherapy treatments, came from the Acupuncture Association of Chartered Physiotherapists (AACP).

I would challenge this argument.

The evidence base for some physiotherapy interventions do indeed have weak (or no) supporting evidence but others interventions do and as far as I can tell more so than acupuncture.

This raises the question which physiotherapy body did the DH consult? The AACP, with its vested interest in promoting acupuncture on the NHS?

@Dudeistan
No doubt it is true that evidence is quite weak for some -even most -physiotherapy. The point, though, is that you recognise that and try to do something about it. Furthermore, physiotherapy speaks the same language as the rest of medicine. In physiotherapy there is none of the mystical gobbledygook or mumbo jumbo that plagues acupuncture.

Furthermore, if a physiotherapist is presented with good evidence he/she is likely to believe it. This is in contrast to most acupuncturists who simply ignore evidence if it fails to support their rather bizarre practices.

Yes David Colquhoun, I am the same Andrew Hoyle that works for the National Institute of Medical Herbalists – do I really need to declare an interest to ask you to clarify a point of information? I was not propagating any view by asking this question (yet another misleading insinuation you have made!)

As you have now admitted that the statement you made “most of the responses come from High Street herbailsts” (sic) was without foundation, can you please apologise for making a misleading statement (I will not use the word “lie” although the thought does pass through my mind).

Actually if you stopped to think about the statement you would realise it was absurd thing for you to say. There are only about 800 qualified medical herbalists in the United Kingdom (which you can verify for yourself by checking the NIMH website). The unqualified herbalists are hardly likely to vote for statutory regulation. Therefore even if all the qualified medical herbalists were to vote for regulation they would only be a fraction of the 6,000 total.

I think you need to accept (however painful this may be for your ego) that when the issue was put to the ordinary people of this country you lost the argument.

Evidently you do not understand the ethics of science. Vested interests must always be declared. Perhaps that is understandable, since you obviously don’t know much about science, and I guess that salesmen don’t feel the same scruples.

I imagine that all the other responses were from members of the public rounded up by your PR agents. You boast that you alone have, as part of you job “Managing e-mail campaigns to database of 1,600 contacts”

The fact of the matter is that you make your living selling herbs and you make claims for their effects which you cannot justify by evidence. I’m puzzled about how your conscience allow you to make a living in that way.

“This is also a very satisfying slap in the face for Ben Goldacre, Ezard Ernst, David Colquhoun and all the other self-appointed ‘experts’ and publicity seekers who have made it their business to oppose Statutory Regulation”

That is one level at which to conduct the argument, but I’d much prefer that you gave us the evidence that the products that you sell have any benefit for the people who buy them. Perhaps you could give us some examples?

I notice that even you describe the evidence for benefit, and of safety, from your new product, Sceletium tortuosum, as “anecdotal”, yet you are selling it to be swallowed by human beings, to make money.

Money is really the basis of the problem. There were relatively few responses from scientists and medics because most are far to busy looking for real cures to spend time writing lengthy responses about pseudo-medicine, That is tedious and unpaid work.

This time, money has won, for the moment. I do wonder though, how the HPC will deal with the flood of complaints that they are bound to get about those who are registered with it.

@Andrew Hoyle
I never pretended that was more than assumption, based on the fact that no scientist or medic that I have met thinks that statutory regulation is a good idea.

What is more to the point is that you have still not responded to my challenge to tell us which herb has the best evidence for efficacy. It’s hard to avoid the conclusion that you are unable to produce a single example. But you are paid to sell the stuff and not to care whether or not it works.

I can’t imagine how you sleep at night. Wouldn’t it be better to get an honest job in a different industry?

I admire your attempts to change the subject Professor Colquhoun, but perhaps I can remind you of the statement you made:

“The DH report is, in a sense, democratic. They have simply counted the responses, for and against each proposal. They seem to be quite unaware that most of the responses come from High Street herbailsts whose main aim is to gain respectability.”

This is a clear and unambiguous statement with no qualification, “maybe” or hint of doubt.

Whereas actually you have simply made up the statement about “High Street herbalists” to support your argument.

In other words you have told a lie to get round the fact that the Consultation (which is an established constitutional process) has gone against you.

As your lie was in the middle of a long list of other forceful statements one is obliged to wonder how many other lies you have told in this piece?

You could at least apologise Professor Colquehoun. Or must we add petulant bad manners to the verdict of dishonesty?

@Professor Colquhoun
I’m glad to see you’ve abandoned the term ‘useful’ and returned to ‘efficacy’ thus avoiding the need for a stipulative definition. I wouldn’t be surprised if a test for efficacy of herbal ‘medicine’ that excluded a consultation with the herbalist failed to show even a placebo effect. My view is that herbalists are psychotherapists with herbs. Where the art therapist has a palette and whole paintbox of colours the herbalist has a mortar and pestle and a whole Physic Garden of herbs. The common factor in both is the human interaction of the consultation from which the placebo emerges.

@Professor Colquhoun
Hello again
I think that our interactions here on your blog and your interaction with others have gone quite some way to demonstrate that you are a proponent of a fundamentalist point of view.
I have attempted to put across another viewpoint to you, only of course to be shot down in flames by yourself and then systematically by your firing squad of minions, because it does not fit in with your viewpoint (shared of course by your supporters), which seems mainly to be – ‘I am right, and everyone else is an idiot’.
I feel saddened by the fact that you must have endured a negative experience of complementary therapy that has propelled you to lead this crusade so extremely.
I do share your fear of unqualified unscrupulous people giving bad health advice, but the recent proposed statutory regulation goes some way to address this. Not all herbal medicine practitioners should be tarred with the same brush quite so unilaterally as you do in your public writings. Rubbishing a 3 or 4 year university degree based on a couple of slides that you have viewed is unfair, what about all the other subjects they are taught, as well as the history of herbal medicine and ancient approaches to diagnosis (which seems to be the slides you viewed). Yes then there is the subject of no clinical evidence to support the claims that a herb may have on a person’s health. What about thousands, if not hundreds of thousands of years of traditional use? No doubt you dismiss this evidence, because it is a different kind of evidence, because it does not fit with your fundamentalist viewpoint. You keep asking for people to supply you with evidence, and this happens, but you choose to slam it all. What about the fact that many of the drugs you help to make do not work (http://news.bbc.co.uk/1/hi/7263494.stm) – will you or your minions slam Professor Irvine Kirsch (http://www2.hull.ac.uk/science/psychology/our_staff/academics/irving_kirsch.aspx ) as an idiot as well?http://www.huffingtonpost.com/irving-kirsch-phd/antidepressants-the-emper_b_442205.htmlm
Everybody knows that clinical drug trials are highly debatable.
I find it a shame that you use your considerable intellect in this way Professor Colquhoun, you have found yourself (quite literally) locked in a web of your own and others fundamentalism, unable to consider that there are people out there that are not charlatans and quacks as you so derogatorily call them, but quite simply have a different view to healthcare and helping people, who have no desire to fool or hurt anyone and go to considerable lengths to ensure that they do not (by taking university education, registering on appropriate bodies and so on). For a scientist to spread such misinformation quite so deliberately, is unfortunate indeed.
Assuming that of course my comment is not deleted, I now bow my head and await the inevitable firing squad.

@misstickle
I fail to see how asking for evidence can be considered fundamentalist.

Once again, you have failed to produce any evidence whatsoever that alternative treatments work. All you have done is produce some references about regular treatments that don’t work. They are already well known. Kirsch is something of a hero for having rooted out the appalling behaviour of GSK, and establishing that SSRIs are pretty close to being ineffective in mild/moderate depression. What you fail to add is that herbalists have always boasted that St John’s Wort is as effective as SSRIs. Since it seems that SSRIs don’t work, it follows that neither does St John’s Wort.

You say

“Rubbishing a 3 or 4 year university degree based on a couple of slides that you have viewed is unfair”

I have a great deal more than the few slides that I’ve shown on here. In the case of UCLAN’s homeopathy degree (now shut), I have the entire course.

You say

“What about thousands, if not hundreds of thousands of years of traditional use? No doubt you dismiss this evidence, because it is a different kind of evidence, because it does not fit with your fundamentalist viewpoint”

No, i dismiss it because it has been shown to be unreliable. Hundreds of years of experience was used as the justification for blood letting, which actually hastened death. That sort of evidence just doesn’t work.

Concerning “charlatans and quacks”, there is always a fine line between delusion and fraud. I’m quite happy to believe that many practitioners actually believe the meaningless statements that they make, and that their misunderstandings about how one distinguished truth and falsehood are result of poor education rather than a wilful desire to deceive.

I presume that you must be the Miss Tickle who offers Tarot card readings by email for only £5. I wonder, if you are so convinced that they work, why it is that you label your service as being for “entertainment purposes only”.

@Professor Colquhoun
Hello again dear Professor,
Thank you for that lovely left hook of a last comment, beautifully done indeed. I was expecting a little more scathing a response but no doubt your minions will chirp in in good time.